treatment of sports injuries (25,26). This has led to a significant demand for postgraduate courses and seminars that include exercise and stretching components for such osteopaths to attend (9). In fact, for an increasing number of osteopaths, it has also led to closer interprofessional relationships, with increased mutual referrals between osteopaths, physiotherapists and a variety of sports exercise professionals.

mad people. Osteopaths have traditionally worked within a discrete

world that consists of their own patients and fellow osteopaths. One of the key benefits of being involved in the sports world comes from working closely with other professions, not only as an educational opportunity but also because it often appears to be an experience that shapes the way that such osteopaths interact with colleagues from other professions throughout their consequent careers. The team of osteopaths, physiotherapists, podiatrists, massage therapists, Pilates teachers, acupuncturists and doctors, for example, who work with the authors regularly cross-refer, seek each other’s advice and collaborate on the treatment of their patients. This is of course the common experience of people working in the sports-medicine world and reflects the value that open-minded, motivated and committed therapists often place on utilising the knowledge, skills and experience of their colleagues from other professions.

There are many osteopaths who work regularly with

the UK’s various sporting teams and organisations. This position has been achieved due to the number of athletes and coaches who have wanted to access osteopathic treatment at their club. It is also the result of the open- minded and supportive approach of the various doctors and physiotherapists who have welcomed osteopathic colleagues to work alongside them. Among these osteopaths are a number of high-profile sports medicine doctors in the UK who have gone on to extend their medical expertise by studying on one of the osteopathic degree courses. One of the ways in which osteopathy differs from other

therapies is that the osteopathic principle of “structure governs function” (4) demands that the whole body always be considered when treating an athlete. Osteopaths working in sport have learnt that there is value in using exercise as an adjunct to physical therapeutic

Sliding articulation of tibia on femur

CASE EXAMPLE A 28-year-old professional footballer had two years of left-sided groin pain, which, in spite of extensive periods of rest, non-steroidal anti-inflammatory drugs (NSAIDs), therapy, corticosteroid injections and surgery (for a “sportsman’s hernia”), had continued to progress and was now associated with right-sided groin pain, lower back pain, an ache in the left hip, and a constant ache and recurrent gastrocnemius injuries in the left calf. An osteopath was called in by the club doctor for another opinion.

Osteopathic examination revealed no abnormalities of basic neurological and cardiovascular testing. However, among the various positive findings, those that were of relevance included an anteriorly rotated right innominate bone, an absence of back-locking in both knees, a fixation of the lumbosacral joint (SIJ) on the left into extension, poor active and passive thoracic rotation, and various muscle imbalances, with some muscles exhibiting significant shortening.

A treatment plan was agreed with the club doctor, an

evolving process that started with twice-weekly osteopathic treatments. Treatment focused initially on mobilising the right innominate bone into a more posterior position, improving the rotation in the thoracic spine (the lack of thoracic rotation was a significant factor in the inability for the SIJ to avoid repeated overstrain), mobilising L1/2/3 on the right (compensating for the classic “osteopathic lesion” finding of a locked facet joint cephalic and contralateral to the main injury site), decompressing the left-sided lumbosacral joint (and thus reducing the effects of sciatic nerve entrapment), and stretching out the hamstring muscles (primarily biceps femoris), popliteus and gastrocnemius (especially the lateral head) to allow more extension in the knee. A podiatrist’s input was also sought, as there was a combination of bilateral pronation (greater on the left) and tendency towards hallux vagus on the left; functional orthoses were therefore prescribed.

After the first three weeks of treatment, the player returned to first-team games. He was then given a personalised stretch programme, and a gym-based exercise regime was initiated, in conjunction with one of the club’s physiotherapists, to address the shortened muscles and to focus on the specific imbalances that had resulted from adapting to a chronic injury.

Although osteopathic treatment thereafter became a

SURGERY. TRADITIONALLY TREATING WHAT IS OFTEN TERMED “AN OSTEOPATHIC LESION”

10

OSTEOPATHS WORK TO RESTORE THE BODY TO A STATE OF BALANCE, WHERE POSSIBLE WITHOUT THE USE OF DRUGS OR

sportEX medicine 2009;42(Oct):7-12